Neighbourhood deprivation and incidence of coronary heart disease: a multilevel study of 2.6 million women and men in Sweden

Abstract

Study objective: To examine whether neighbourhood deprivation predicts incidence rates of coronary heart disease, beyond age and individual income. Design: Follow up study from 31 December 1995 to 31 December 1999. Women and men were analysed separately with respect to incidence rates of coronary heart disease. Multilevel logistic regression was used in the analysis with individual level characteristics (age, individual income) at the first level and level of neighbourhood deprivation at the second level. Neighbourhood deprivation was measured at small area market statistics level by the use of Care Need Index. Setting: Sweden. Participants: All women and men aged 40-64 in the Swedish population, in total 2.6 million people. Main results: There was a strong relation between level of neighbourhood deprivation and incidence rates of coronary heart disease for both women and men. In the full model, which took account of individual income, the risk of developing coronary heart disease was 87% higher for women and 42% higher for men in the most deprived neighbourhoods than in the most affluent neighbourhoods. For both women and men the variance at neighbourhood level was over twice the standard error, indicating significant differences in coronary heart disease risk between neighbourhoods. Conclusions: High levels of neighbourhood deprivation independently predict coronary heart disease for both women and men. Both individual and neighbourhood level approaches are important in health care policies.

Neighborhood context and ethnicity differences in body mass index: A multilevel analysis using the NHANES III survey (1988–1994)

“…In sum, women may be more reliant on neighborhood resources or men are more influenced by extra-residential factors, or both. However, other studies have found stronger associations between composite measures of neighborhood disadvantage and mortality among men than among women (Sundquist et al, 2004;Nordstrom et al, 2004). Further exploration is required to ascertain mechanisms driving these differences.…”

Predictors of Overweight and Obesity Among Women in Ghana

“…Similarly, employed women had higher odds (1.45, p=0.002) of being overweight or obese compared to their unemployed counterparts. Several theories have been postulated on the possible relationships between income and weight, which are positive, negative or inverted U-shaped [41,46,49]. Demand for food that raises weight could increase with increase in income.…”

Inequities in CHD Incidence and Case Fatality by Neighborhood Deprivation

“…In general, this research has shown significant neighborhood-level effects after "adjustment" for potential confounding factors including individual-level socioeconomic status/position. 4,[6][7][8][9][10] This area of research is particularly germane to women as previous work suggests that residence in a deprived neighborhood may affect the cardiovascular health of women to a greater extent than men. 6, 7…”

“…7 Using a neighborhood medical care need index, Sundquist et al reported odds ratios among adults in the most versus the least deprived neighborhoods of 1.9 and 1.4 for women and men, respectively, after adjustment for individual-level age and income (14,259 events). 6 Neither of these studies examined neighborhood-level effects on CHD across a broad array of sociodemographic groups, tested for differences by gender, or examined effects on case fatality, an indicator of severity of disease and quality of care. Separate studies have examined the relationship between area-based measures and case fatality/survival following an acute myocardial infarction 11-15 and while all found significant associations, only one presented neighborhood results separately by gender, 12 and none presented case fatality from overall CHD.…”